PT - JOURNAL ARTICLE AU - Teo, Yao Neng AU - Sia, Ching-Hui AU - Tan, Benjamin Y Q AU - Mingxue, Jing AU - Chan, Bernard AU - Sharma, Vijay Kumar AU - Makmur, Andrew AU - Gopinathan, Anil AU - Yang, Cunli AU - Loh, Stanley AU - Ng, Sheldon AU - Ong, Shao Jin AU - Teoh, Hock-Luen AU - Rathakrishnan, Rahul AU - Andersson, Tommy AU - Arnberg, Fabian AU - Gontu, Vamsi Krishna AU - Lee, Tsong-hai AU - Maus, Volker AU - Meyer, Lukas AU - Bhogal, Pervinder AU - Spooner, Oliver AU - Li, Tony YW AU - Soh, Rodney YH AU - Yeo, Leonard LL TI - Combined balloon guide catheter, aspiration catheter, and stent retriever technique versus balloon guide catheter and stent retriever alone technique: a systematic review and meta-analysis AID - 10.1136/neurintsurg-2021-018406 DP - 2023 Feb 01 TA - Journal of NeuroInterventional Surgery PG - 127--132 VI - 15 IP - 2 4099 - http://jnis.bmj.com/content/15/2/127.short 4100 - http://jnis.bmj.com/content/15/2/127.full SO - J NeuroIntervent Surg2023 Feb 01; 15 AB - Background The use of a combination of balloon guide catheter (BGC), aspiration catheter, and stent retriever in acute ischemic stroke thrombectomy has not been shown to be better than a stent retriever and BGC alone, but this may be due to a lack of power in these studies. We therefore performed a meta-analysis on this subject.Methods A systematic literature search was performed on PubMed, Scopus, Embase/Ovid, and the Cochrane Library from inception to October 20, 2021. Our primary outcomes were the rate of successful final reperfusion (Treatment in Cerebral Ischemia (TICI) 2cā€“3) and first pass effect (FPE, defined as TICI 2cā€“3 in a single pass). Secondary outcomes were 3 month functional independence (modified Rankin Scale score of 0ā€“2), mortality, procedural complications, embolic complications, and symptomatic intracranial hemorrhage (SICH). A meta-analysis was performed using RevMan 5,4, and heterogeneity was assessed using the I2 test.Results Of 1629 studies identified, five articles with 2091 patients were included. For the primary outcomes, FPE (44.9% vs 45.4%, OR 1.04 (95% CI 0.90 to 1.22), I2=57%) or final successful reperfusion (64.5% vs 68.6%, OR 0.98 (95% CI 0.81% to 1.20%), I2=85%) was similar between the combination technique and stent retriever only groups. However, the combination technique had significantly less rescue treatment (18.8% vs 26.9%; OR 0.70 (95% CI 0.54 to 0.91), I2=0%). This did not translate into significant differences in secondary outcomes in functional outcomes, mortality, emboli, complications, or SICH.Conclusion There was no significant difference in successful reperfusion and FPE between the combined techniques and the stent retriever and BGC alone groups. Neither was there any difference in functional outcomes, complications, or mortality.All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.